Abstract
Measurement of renal function is important to optimize drug dosing in critically ill pediatric patients and to prevent dose-related toxicities caused by medications that are eliminated or metabolized by the kidney. In clinical practice, the 24-h creatinine clearance (CrCl) is used as a surrogate marker of renal function. However, a 24-h urine collection period delays the availability of the result and increases the potential for collection errors. This prospective, observational study was performed to determine whether a 12-h CrCl is comparable to the traditional 24-h CrCl and to assess whether CrCl could be reliably predicted by the Schwartz equation, which mathematically estimates a child's GFR. A 24-h urine sample was collected in two 12-h aliquots from 60 catheterized critically ill children (age 2 d to 18 y). CrCl and Schwartz glomerular filtration rate (GFR) estimates were determined for each 12- and 24-h period. Agreement between 12- and 24-h CrCl and between CrCl and Schwartz GFR estimates was assessed using intraclass correlation coefficients (ICCs). An ICC ≥0.8 was considered to indicate excellent agreement. The ICC between the first 12-h CrCl and 24-h CrCl was 0.9605. The ICC between the second 12-h CrCl and 24-h CrCl was 0.9602. The ICC between the 24-h CrCl and Schwartz GFR was only 0.7046. All comparisons of 12- and 24-h CrCl indicated excellent agreement. In summary, the Schwartz equation was not a reliable estimate of renal function in critically ill children, and a 12-h CrCl is just as accurate as the standard 24-h CrCl to assess renal function and guide drug dosing.
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Abbreviations
- CrCl:
-
creatinine clearance
- GFR:
-
glomerular filtration rate
- ICC:
-
intraclass correlation coefficient
- ICU:
-
intensive care unit
- SCr:
-
serum creatinine
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Acknowledgements
We gratefully acknowledge the assistance and support of the nurses and physicians from the critical care unit. We also acknowledge both the Departments of Pharmacy and Critical Care Medicine at the Hospital for Sick Children for strong support and generous funding of this project.
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Supported by the Department of Critical Care Medicine and the Pharmacy Department Research and Education Fund.
Abstract previously published in Can J Hosp Pharm 2003;56(suppl):S48.
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Pong, S., Seto, W., Abdolell, M. et al. 12-Hour versus 24-Hour Creatinine Clearance in Critically Ill Pediatric Patients. Pediatr Res 58, 83–88 (2005). https://doi.org/10.1203/01.PDR.0000156225.93691.4F
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DOI: https://doi.org/10.1203/01.PDR.0000156225.93691.4F
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